Healthcare Provider Details

I. General information

NPI: 1881160687
Provider Name (Legal Business Name): CARLOS M DIAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6336 PICCADILLY SQUARE DR
MOBILE AL
36609-5143
US

IV. Provider business mailing address

6336 PICCADILLY SQUARE DR
MOBILE AL
36609-5143
US

V. Phone/Fax

Practice location:
  • Phone: 251-999-5433
  • Fax: 251-255-8474
Mailing address:
  • Phone: 251-999-5433
  • Fax: 251-471-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD.43350
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.43350
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: